OTC: Specialists in Obesity

IHOP—SIN OR THIN?

From:  John Hernried, M.D.

         

I will confess that I ate dinner at IHOP yesterday.  I picked up my kids at 6:30  after their tortuous day of school and activities and we were all starved.  The thought of preparing dinner was daunting.  My seven year old wanted to choose and insisted on IHOP.

I have mixed feelings about International House of Pancakes.  I have fond memories as a child stuffing myself beyond full with pancakes topped with strawberries, whipped cream and syrup.  Some things don’t change in that the menu is about the same and most of the food “feels” greasy and unhealthy to me. Yet, when a hungry seven year old looks you in the eye and says “please”—resistance is futile.

We were promptly seated and handed a new menu.  The redesigned menu had new, greasy choices but it also had nutritional recommendations and substitute suggestions. In addition, there was a reference to a healthier menu, which was not offered to me when we sat down.  I asked for the new “IHOP for Me” menu and was pleasantly surprised to find some good choices with calories listed.  I enjoyed a vegetable scramble which was loaded with fresh vegetables.  It came with a two fair sized pancakes and was not topped with butter. I enjoyed a nice dinner for about 600 calories.  Other options on this menu include fish, chicken and various low carb options.  Interestingly, there were no salads on this menu and the focus was still on meat, eggs and pancakes.

The children’s menu was also redesigned and they had several healthier options on the right side of the placemat menu.  But let’s be realistic.  When children are given the choice of a large pancake with a whipped cream smiling face versus “junior cod”—do you really think I can get them to make a good choice?  It was a great opportunity for a teaching moment for my boys—but afterwards they chose the smiling pancake.

Why is IHOP making these changes?  Perhaps public tastes are changing.  However, it is more likely due to political action and media attention.  They only had four of the special menus for the entire restaurant and skewed the children’s menu towards high fat, sugar and calorie choices.  This shows that the restaurant industry still has not bought into the public health concerns about our food intake.  Still, it is a start and I hope other restaurants will offer better choices with nutritional labels on the menu.

NEAT

From: John Hernried, M.D.

      

NOTE: PLEASE READ THIS ENTRY WHILE STANDING UP

While my professional focus is on the treatment of adult obesity, I am interested in efforts to prevent obesity in childhood.  There has been considerable discussion how to make children more active.  I know firsthand what a challenge this is..  In my family, we really have to “work at” keeping my boys physically active. Organized sports may not be the only solution.

Researchers at the Mayo Clinic are looking into changing the classroom to allow children to have purposeful activity while they are learning.   It is a fascinating story of collaboration and use of technology to create a classroom that has children standing and moving most of the day.  The details include:

• Video-streamed "pod-casting" as a teaching aid

• "Learn 'n Move" bays -- a step beyond traditional learning stations

• Wireless technology

• Personalized laptop computers

• An earpiece that measures physical activity of the student

• Vertical magnetic work spaces that double as projection screens

• Innovative telemetry that collects data for scientific comparison

• Personalized white boards (instead of one large blackboard for a room)

• "Standing" desks -- where the children will stand and work, rather than sit

For details and more photos, please see this Mayo Clinic link.

The concept behind this “Classroom of the Future” is a concept called N.E.A.T.  This stands for Non-Exercise Activity Thermogenesis. It is the number of calories burned during our daily activity at home and work.  By standing up and reading this blog, you are increasing your NEAT. With modern technology (remote controls, automated vacuums, working at a computer rather than a factory line) we burn about 100-200 fewer NEAT calories than we used to.  This may account for some of the obesity epidemic. 

We always think we have to run marathons to keep our weight down.  But there is some evidence NEAT actually decreases as we exercise more.  The result is that for some people, they may still gain weight while they exercise. Not to be discouraged. At OTC, we are looking at ways to measure NEAT and planned physical activity to best help our patients.

I can only hope there is a “classroom of the future” for my sons in the near future. 

Exercise and Heart Disease

From:  John Hernried, M.D.

          

I lost a good friend recently.  He was a man I admired for his  youthful outlook and spirit.  At 62, he loved nothing more than skiing. I hope to be as excited about skiing when I am his age.  Yet, he also told me about some alarming symptoms he had while skiing, including blacking out a couple of times during a run.  Even though he was a friend and not a patient, I put my doctor hat on and told him that I was concerned and asked him to see a doctor.  He promised after several further prompts from me not to ski until he was checked out.  For whatever reason, he decided to follow his own voice and ignore my pleas.  He died of a heart attack while skiing down a slope.  As a physician, I am frustrated that he did not listen to my warnings. His death was preventable.  As a friend, I am sad for the loss and I will miss him. I take some comfort knowing that he died the way he would have wanted..

Many people engage in strenuous physical activity after being sedentary for long periods of time.  This burst of activity can be the result of New Year’s resolutions , wintertime activities such as shoveling snow or skiing, or being lured into one of the specials at the local gym.  Yet, not everyone should automatically start up a program without seeing a physician.  When should you get checked out?

At OTC, as part of our new weight loss/exercise program called Re-Entry Plus, we evaluate each person prior to approving exercise.  For those who may have risk for silent heart disease, we ask that this be evaluated by a primary care physician or cardiologist before beginning exercise. 

How about you?  Should you see a physician before you begin to exercise?  My answer is when in doubt, consult your physician.  If you are curious you can take the test called the Par-Q on this link. If you answer yes on any of the questions, please make your appointment with your doctor and bring in a copy of the questionnaire.

The next time I am on the slopes will be very bittersweet for me.  My words could not help my friend, but I hope that they will help someone who reads this blog.

Glycemic Index: Friend or Foe?

From: John Hernried, M.D.

         

It has been quiet on the fad diet front.  I have not seen any evidence of a radical new wave since the “death of low-carb” (which is still alive and kicking by the way).  However, I am beginning to hear the overtones of a fad surrounding the glycemic index.  In general, the fad diet lifecycle starts with an unproven concept, hits the media and internet, is then embraced by the food industry who sells all kinds of products, and finally falls out of favor when everyone realizes it doesn’t work. 

The glycemic index is nothing new.  The idea is that certain carbohydrates have different effects on blood sugar and insulin levels and therefore appetite and weight. There is some science behind it in that in that the number is determined in a lab setting where patients are fasting overnight and are fed pure isolated food (like one potato or one cup of rice). 

However, when it comes to weight loss, I do not see it as a magic cure for several reasons:

1. The major reason is that we don’t eat a particular food in isolation. We eat a greasy hamburger (low glycemic index) with a soda (moderate glycemic index) and french fries (high glycemic index).  How do you determine the glycemic index when it is all mixed together in the stomach?

2. It complicates what should not be a complicated system.  Basically, fiber allows for a lower glycemic index.  Therefore, fibrous fruits and vegetables are the key to a low glycemic diet.  This is something OTC recommends anyway as part of a balanced diet in weight maintenance.

3. There is little evidence for the effectiveness for weight loss using the glycemic index in non-diabetic patients.  Yet, there are 87 books listed on Amazon promoting the glycemic index.

Save your money and don’t buy any special books or commercial foods advertising the miracles of glycemic index. If you want to try it, please memorize the glycemic index of each of these 750 foods listed on this link. Imagine the power of sharing this information at dinner parties!

Otherwise, just focus on whole grains and fibrous fruits and vegetables to maintain your weight and health. What could be easier that that?

Death By Fork?

From: Maureen Allen, M.P.H.

               

Recently, 40 year-old actor Chris Penn, younger brother of Sean Penn died. Cause of death is cardiomyopathy, a bad heart.

After his death, a British news organization quoted a friend of Penn’s commenting on Penn’s many compulsions, among them binge eating. The friend described his last binge, the one he had the day before he died. His menu included a large steak, several chocolate milkshakes, several pints of beer and fish and chips. According to him, it was not an isolated incident. We may never know if Penn actually had binge eating disorder but it is no secret he was overweight.

Binge eating is an eating disorder described as frequent episodes of eating what others would consider large amounts of food without being able to control what or how much is being consumed. Some other behaviors associated with binge eating disorder are eating very rapidly, eating until uncomfortable, eating when not physically hungry and eating alone out of embarrassment and feeling ashamed once the binge is over. Binge eaters range from normal weight to severely obese. Anorexia nervosa and bulimia are more well-known, but binge eating disorder is just as serious, distressing and life threatening as the others. This is mostly due to the diseases caused by obesity.                       

February 26 through March 4, 2006 is National Eating Disorder Awareness Week. Binge eating disorder can be treated if the behavior of binge eating is part of the treatment plan. If you suspect you have binge eating disorder, talk to your doctor. It won’t be easy, but neither is living with guilt and shame.